Systematic Review and Meta-analysis: Depressive Symptoms and Risky Behaviors Among Adolescents in Low- and Middle-Income Countries - 20/01/22
, Lucy Desborough, PGCert d, Alan Stein, FRCPsych a, b, Andrea Cipriani, MD a, cAbstract |
Objective |
Several studies conducted in high-income countries have found an association between depressive symptoms and risky behaviors among adolescents. Evidence from low- and middle-income countries (LMICs), where 90% of the world’s adolescents live, remains scarce. This meta-analysis systematically reviewed evidence examining the association between depressive symptoms and risky behaviors among adolescents in LMICs.
Method |
Fifteen electronic databases were searched for published or unpublished cohort and case-control studies about adolescents in LMICs. The primary outcome was the association (odds ratio [OR]) between depressive symptoms and risky sexual behavior and substance use. Secondary outcomes included delinquency, adverse school behavior, self-harm, and suicidal behavior. ORs from all studies were pooled using the random-effects model. Quality of studies was assessed using the Newcastle-Ottawa scale, and strength of the overall body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.
Results |
Searches yielded 31,148 potentially relevant studies. After screening, 33 studies were included in the systematic review, of which 30 comprised the meta-analysis. Studies encompassed 35,918 adolescents living in 17 LMICs: 5 from Africa, 7 from Asia, and 5 from Latin America and the Caribbean. Adolescents with depressive symptoms were more likely to engage in risky sexual behavior (OR 1.3 95% CI 1.1-1.5) and substance use (OR 1.8, 95% CI 1.4-2.2) compared with nondepressed adolescents. Results for secondary outcomes showed a similar pattern, with higher delinquency (OR 3.2, 95% CI 1.8-5.6), self-harm (OR 4.4, 95% CI 1.3-14.4), and suicidal behavior (OR 6.6, 95% CI 2.3-18.9) among adolescents with depression compared with healthy adolescents.
Conclusion |
This study suggests that adolescents with depression in LMICs carry a double burden: depression and increased risk of engaging in risky behaviors. This combination may lead to further psychological and physical health problems that persist over the life course and may impose a health burden on society as a whole. Taken together, these findings highlight the urgent need for scalable and sustainable approaches to prevent and/or treat depression among adolescents in resource-poor settings.
Le texte complet de cet article est disponible en PDF.Key words : adolescents, depressive symptoms, low- and middle-income countries, risky behaviors
Plan
| J.R.P. and A.S. are funded by the MRC Newton Fund (grant MR/S008748/1) and the Wellspring Philanthropic Foundation (grant ID 13711). J.R.P. also received funding support from Fundación Rafael del Pino. A.S. additionally receives funding support from the UKRIGCRF Accelerating Achievement for Africa’s Adolescents Hub and by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre (grant BRC-1215-20005). A.C. is supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration, and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). None of the funding sources played a role in the writing of the manuscript or the decision to submit it for publication. Further, the views expressed are those of the authors and not necessarily those of the funding sources. |
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| This work has been prospectively registered: display_record.php?RecordID=131262. |
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| Author Contributions Conceptualization: Pozuelo, Stein, Cipriani Data curation: Pozuelo, Desborough Formal analysis: Pozuelo, Cipriani Investigation: Pozuelo, Desborough Methodology: Pozuelo, Cipriani Project administration: Pozuelo Software: Pozuelo, Desborough Supervision: Stein, Cipriani Validation: Desborough Visualization: Pozuelo Writing – original draft: Pozuelo Writing – review and editing: Pozuelo, Desborough, Stein, Cipriani |
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| Many thanks to the authors who facilitated access to previously unpublished disaggregated data, and to the 3 anonymous reviewers for their helpful comments. Thank you to Bruna Gonçalves Cordeiro da Silva, PhD, and Ana M.B. Menezes, MD, of Federal University of Pelotas, for conducting the analysis with the Pelotas Birth Cohort Study in Brazil; to Eli Harriss, MA, MSc, of University of Oxford, for contributing to the methodology and data collection and advising on the search strategy design; to Ni Xu, MBBS, of University of Oxford, and Farhad Shokraneh, PhD, of Systematic Review Consultants, for their help with translations from Chinese and Persian, respectively; and to Max Roser, PhD, of Our World in Data and University of Oxford, for support on data visualization. |
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| Disclosure: Profs. Stein and Cipriani, and Mss. Pozuelo and Desborough have reported no biomedical financial interests or potential conflicts of interest. |
Vol 61 - N° 2
P. 255-276 - février 2022 Retour au numéro
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